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General NPI Number Information
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NPI Number | 1841833654
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Entity Type | Individual
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Provider Name | DEEPTI MISHRA LPC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 425 CARLISLE DR STE A
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City | HERNDON
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State | VA
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Zip | 20170-5618
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Country | US
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Telephone | 571-508-8980
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Fax |
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Provider Business Mailing Address
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Address Line | 12207 MEADOWSTREAM CT
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City | HERNDON
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State | VA
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Zip | 20170-2748
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Country | US
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Telephone | 703-624-7190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008624
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License Number State | VA
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